title: Effects of prone and supine positions on sleep state and stress responses in preterm infants.
abstract: OBJECTIVE
  The purpose of the study is to assess the influence of prone or supine position on sleep states and on withdrawal and approach reactions of preterm infants.
  
  
  METHODS
  Thirty-two preterm infants from Meir Medical Center, Israel, mean post menstrual age 30.37±2.57, mean birth weight 1250g±313.86, participated in the study. Infants were studied during 48h. Positions (prone and supine) were alternated every 3-4h after feedings. Sleep states were assessed by Actigraph measurement and by two daily 30-min Naturalistic Observations of Newborn Behavior (NONB) to confirm sleep states and for recording the behavioral reactions (approach and withdrawal).
  
  
  RESULTS
  In the prone position there were more approach reactions as compared to withdrawal reactions (p<.001) while in the supine position, the approach and withdrawal reactions were comparable. In the prone position more sleep patterns (deep sleep, light sleep, drowsy) were observed as opposed to more awake patterns (quiet awake, active awake and agitated fussy) that were seen in the supine position.
  
  
  CONCLUSIONS
  Clinical implications encourage placing the preterm infant in the prone position while in the NICU. This enables important achievements such as longer periods of quality sleep, and production of adaptive self-regulatory reactions.
authors.affiliation: Department of Occupational Therapy, School of Allied Health, Medical Faculty, Tel Aviv University, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Jarus
authors.forename: O
authors.initials: O
authors.lastname: Bart
authors.forename: G
authors.initials: G
authors.lastname: Rabinovich
authors.forename: A
authors.initials: A
authors.lastname: Sadeh
authors.forename: L
authors.initials: L
authors.lastname: Bloch
authors.forename: T
authors.initials: T
authors.lastname: Dolfin
authors.forename: I
authors.initials: I
authors.lastname: Litmanovitz
mesh_terms: D056044:Actigraphy / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D016684:Prone Position / Q000502:physiology*; D012894:Sleep Stages / Q000502:physiology*; D013315:Stress, Psychological / Q000503:physiopathology*; D016683:Supine Position / Q000502:physiology*; D014851:Wakefulness / Q000502:physiology